Summary

The management of Takayasu arteritis (TAK) remains challenging due to its relapsing nature, often requiring long-term therapy over years. Given the risks of refractory disease and glucocorticoid-related (GC) toxicity, safe and sustained GC-sparing strategies are essential. The 2021 ACR/VF guidelines currently favor tumor necrosis factor inhibitors (TNFi) over tocilizumab (TCZ) as initial therapy, based on greater clinical experience and supporting data [1]. However, direct comparative studies are lacking. By providing head-to-head efficacy and safety data on adalimumab (ADA) versus TCZ, the study aims to clarify which biologic agent may offer superior short-term and long-term benefits in patients with active and severe TAK [2].

This randomized, controlled, open-label study enrolled 40 patients who were treated with either ADA (n=21) or TCZ (n=19), both combined with GCs and methotrexate. The primary endpoint was the efficacy rate (ER) at 6 months, with secondary endpoints including ER at 9 and 12 months, relapse rate, GC tapering, adverse effects, and quality of life changes during treatment.

The results demonstrated that the ER at 6 months was significantly higher in the ADA group compared to TCZ in the intention-to-treat population (P=0.02), with a similar trend observed in the per-protocol analysis (P=0.06). By 9 and 12 months, efficacy rates were comparable between groups. The proportion of patients achieving glucocorticoid tapering to ≤10 mg/day at 6 months did not differ significantly (P=0.83). Relapse rates and adverse event frequencies over the 12-month follow-up were also similar (P=0.96 and P=0.55, respectively). For detailed statistics, see the following table.